Provider Demographics
NPI:1982909180
Name:PENA-OLSON, SUMMER ASHLYAN
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:ASHLYAN
Last Name:PENA-OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUMMER
Other - Middle Name:ASHLYAN
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MP
Mailing Address - Street 1:1650 HALLIE RD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6521
Mailing Address - Country:US
Mailing Address - Phone:715-328-3392
Mailing Address - Fax:
Practice Address - Street 1:1650 HALLIE RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6521
Practice Address - Country:US
Practice Address - Phone:715-382-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist